The Role of Blood Markers in Predicting Ectopic Pregnancy Outcomes

by

Introduction

Ectopic pregnancy is a very often potentially life-threatening syndrome wherein an already fertilized egg starts implanting outside the uterus, normally in the fallopian tube. Early diagnosis and appropriate treatment for EP is highly recommended because of a high risk for maternal morbidity and mortality, especially during the first trimester. Proper care and prompt diagnosis of EP are of great importance. 

Blood markers are one of the most valuable tools for the diagnosis and prognosis of ectopic pregnancies. Beta-human chorionic gonadotropin (β-hCG), complete blood count (CBC) values, and other serum markers play an important role in the diagnosis of EP, evaluating the severity of the disease, and predicting the outcome of drug treatments or the need for surgery. For instance, levels of β-hCG and other such markers as NLR or neutrophil-to-lymphocyte ratio and PDW or platelet distribution width can predict the response of medical intervention in a patient with an ectopic pregnancy, even to methotrexate therapy.

The Importance of Early Diagnosis and Blood Markers

There is a great deal of need for early detection of an ectopic pregnancy to avoid some problems like rupture of the tube, internal bleeding, and even death in extreme cases. Blood indicators help assess the effectiveness of meds like methotrexate, which are commonly prescribed for patients medically stable, and to predict the existence of an ectopic pregnancy.β-hCG is among the main indicators used for the diagnosis of ectopic pregnancy. The pace of increasing or decreasing levels of β-hCG can be very informative about the viability of pregnancy. In early gestation, levels of β-hCG in normal intrauterine pregnancies rise very rapidly within 48 to 72 hours; whereas in ectopic pregnancies, levels often rise more slowly or even fall. 

There are many literatures that explain how β-hCG levels can usefully direct treatment decisions, as in selection of methotrexate for treatment.β-hCG levels have been shown to be indicative of treatment success. Usually, the decrease in the β-hCG values post-methotrexate treatment often informs whether treatment has been successful or not and necessitates surgery. It is for this reason that β-hCG is an important marker that provides significant documentation both regarding the diagnosis of ectopic pregnancy and during assessment of success of methotrexate and other conservative treatments.

Yearwise Publication Trend on “ectopic pregnancy”

Find publication trends on relevant topics

Complete Blood Count Parameters and Ectopic Pregnancy

Another recent study has assessed the role of complete blood count (CBC) factors in predicting the outcomes of treatments for ectopic pregnancy. It analyzed the prognostic value of a variety of blood markers derived from CBC, which include platelet count (PLT), the distribution width of platelets (PDW), and the neutrophil-lymphocyte ratio (NLR).

Results from a retrospective study of 434 patients who received methotrexate for ectopic pregnancy have shown the NLR to be strongly associated with the outcome of the treatment. In that regard, patients with higher NLR values on the first, fourth, and seventh days of the treatment proved to have a better chance to resolve their ectopic pregnancy without any surgical intervention.This would imply that NLR could be added as an adjunct or even replacement or for β-hCG as a marker for predicting the effectiveness of therapies. Although PDW and PLT counts were comparable between the two groups and showed no marked differences, the association of NLR with effective methotrexate treatment makes the parameters of CBC potentially useful instruments in the management of ectopic pregnancies.

Another compared intrauterine healthy pregnancies with tubal ectopic pregnancies in women in terms of variations of CBC values. The authors showed that, whereas patients with ectopic pregnancies had a significantly reduced level of PDW compared with patients with healthy pregnancies, there was no difference between them in the platelet count or MPV. It should be mentioned that WBC and monocytic levels were significantly increased in the group of ectopic pregnancy. This would therefore mean that the pathophysiology of an ectopic pregnancy is associated with activated monocytes that could influence the tubal motility and control of the microenvironment.

Other Blood Markers: The Role of MicroRNAs

Recent studies have been able to identify microRNAs as potential biomarkers for the early diagnosis of ectopic pregnancy aside from the traditional blood markers, which include β-hCG and CBC characteristics. MicroRNAs are small non-coding RNA molecules that are known to involve the regulation of gene expression. They have shown promises in distinguishing ectopic pregnancies from spontaneous miscarriages and from viable intrauterine pregnancies.

Some microRNAs, which have been indicated as participating in the development of the placenta, circulate within the blood and were shown to express differently in women with ectopic pregnancies. Conclusions drawn from such research tend to indicate that microRNAs may present another level of diagnostic specificity, as they may be used to detect ectopic pregnancies earlier and therefore reduce the risk of rupture of the tubes and other adverse consequences. Further research is needed to validate these markers and standardize their use in clinical practice.

Recent Publications on “ectopic pregnancy”

Find publications on relevant topics

The Predictive Power of Blood Markers in Methotrexate Treatment

The common non-surgical treatment of ectopic pregnancies in women is methotrexate, especially with lower β-hCG levels and stable vital signs and so on. Blood indicators like β-hCG and the CBC features also often predict the outcome of methotrexate medication.

Research has always shown that the higher success rates of methotrexate treatment are found in correlation with lower baseline levels of β-hCG. Most criteria setting up for further treatment when using methotrexate include a β-hCG level less than 5000 IU/L. Patients whose levels stand below the cutoff point have better chances of succeeding with the treatment, but those whose levels are higher may have a higher chance of failure but may, nonetheless, be candidates for surgery.

Besides, as shown earlier in the previous paragraphs, NLR has proven to be an up-and-coming marker predicting the success of methotrexate. A particularly critical component in managing ectopic pregnancy is the difference NLR can make between patients who could probably receive methotrexate and those needing surgery, especially in disadvantaged regions where surgical facilities are not as readily accessible.

Conclusion

Detection, management, and monitoring of ectopic pregnancies call for blood indicators. Techniques range from the widely applied hormone of β-hCG to newly discovered markers such as microRNAs and NLRs. These provide clinicians with information on the severity of the illness as well as on the likelihood of a favorable course. Prediction and follow-up of treatment courses require careful consideration of blood indicators. These, especially in the case of methotrexate therapy, have an impossible predictive value. As efforts aimed at newer biomarkers and advanced benefits from the existing ones continually advance, the care of such ectopic pregnancies will probably be even more precise and individualized, thereby improving outcomes for patients and the decrease in hazards involving this dangerous condition.

References

  1. Kanmaz, A.G., Inan, A.H., Beyan, E. and Budak, A., 2018. Role of various complete blood count parameters in predicting the success of single-dose Methotrexate in treating ectopic pregnancy. Pakistan Journal of Medical Sciences, 34(5), p.1132.
  2. Eskicioğlu, F., Özdemir, A.T., Turan, G.A., Gür, E.B., Kasap, E. and Genç, M., 2014. The efficacy of complete blood count parameters in the diagnosis of tubal ectopic pregnancy. Ginekologia Polska, 85(11).
  3. Fernandez, H., Capmas, P., Lucot, J.P., Resch, B., Panel, P., Bouyer, J. and GROG, 2013. Fertility after ectopic pregnancy: the DEMETER randomized trial. Human Reproduction, 28(5), pp.1247-1253.
  4. Jurkovic, D., Memtsa, M., Sawyer, E., Donaldson, A.N.A., Jamil, A., Schramm, K., Sana, Y., Otify, M., Farahani, L., Nunes, N. and Ambler, G., 2017. Single‐dose systemic methotrexate vs expectant management for treatment of tubal ectopic pregnancy: a placebo‐controlled randomized trial.
  5. Orozco, E.M., Sánchez-Durán, M.A., Bello-Muñoz, J.C., Sagalá, J., Carreras, E. and Roura, L.C., 2015. ß-hCG and prediction of therapeutic success in ectopic pregnancies treated with methotrexate, results from a prospective observational study. The Journal of Maternal-Fetal & Neonatal Medicine, 28(6), pp.695-699.
  6. Vaswani, P.R., 2014. Predictors of success of medical management of ectopic pregnancy in a tertiary care hospital in United Arab Emirates. Journal of clinical and diagnostic research: JCDR, 8(8), p.OC04.
  7. Brady, P.C., 2017. New evidence to guide ectopic pregnancy diagnosis and management. Obstetrical & gynecological survey, 72(10), pp.618-625.

Top Experts on “ectopic pregnancy“